[Relapse in the nasal cavity of a patient with extranodal NK/T-cell lymphoma initially presenting as plantar subcutaneous tumor].

A 36-year-old woman complained of a mass on the sole of her foot in February 200X. She was diagnosed with extranodal NK/T-cell lymphoma, nasal type (ENKL) by skin biopsy. Because the lesion was localized on the subcutaneous tissue of the sole, she was treated with RT/2/3DeVIC, resulting in a complete response (CR). In March of the following year, PET/CT showed significant uptake and mucosal thickening in the right nasal cavity, and a mucosal biopsy confirmed ENKL infiltration. Because the lesion was localized in the nasal cavity, she was re-treated with RT/2/3DeVIC, with a focus on local control, and she achieved a second CR. She subsequently received allogeneic hematopoietic stem cell transplantation in the hope of preventing systemic relapse. She has remained in CR for four years since the transplantation. Our case suggests that allogeneic hematopoietic stem cell transplantation to be a potentially promising approach to curative treatment for recurrent ENKL in younger patients. As nasal lesions may subsequently appear during the course of primary non-nasal ENKL, ongoing meticulous evaluation for nasal lesions is important.

Fatal Trichosporon fungemia in patients with hematologic malignancies.

OBJECTIVE: Invasive Trichosporon infection has been increasingly recognized in patients with hematologic malignancies. Our study aims to clarify the clinical characteristics of this disease and factors influencing patient prognosis. PATIENTS AND METHODS: We retrospectively analyzed 33 cases of Trichosporon fungemia (TF) in patients with hematologic malignancies treated at our collaborating five hospitals in Japan between 1992 and 2007. RESULTS: The majority of these patients had acute leukemia (82%), neutropenia (85%), and a history of intensive chemotherapy (91%). TF occurred as a breakthrough infection during antifungal therapy in 30 patients (91%), 18 of whom were receiving micafungin. The surveillance cultures of most patients were negative for Trichosporon. Only a few patients exhibited elevated levels of 1,3-beta-d-glucan before positive blood culture. Twenty-five patients (76%) died of this infection. The resolution of infection was associated with neutrophil recovery (P = 0.0001), absence of hyperglycemia (P = 0.023), and azole inclusive therapy (P = 0.031). Survival was significantly longer in patients receiving antifungal therapies containing azole than in those who did not receive azole (P = 0.0034). CONCLUSIONS: At present, the diagnosis of invasive trichosporonosis depends on blood culture studies, and the mortality of this disease is high; however, azole therapy and control of blood glucose level, together with hematopoietic recovery could help in improving the clinical outcome. When we use antifungals lacking anti-Trichosporon activity, sufficient care should be taken to prevent the development of breakthrough trichosporonosis.

Clinicopathologic significance of loss of CD19 expression in diffuse large B-cell lymphoma.

To clarify the clinicopathologic significance of a loss of CD19 expression in diffuse large B-cell lymphoma (DLBCL), we evaluated CD19 expression immunohistochemically in frozen sections from 227 patients who had received diagnoses of DLBCL according to the World Health Organization classification between 1987 and 2002. Histopathologic features of patients with CD19- DLBCL were reviewed, and their clinical features, immunophenotypes, and prognoses were compared retrospectively with respect to CD19 expression. CD19 expression was positive in 205 patients (90%). The 22 patients with CD19- DLBCL had a median age of 63 years, and the male-female ratio was 11:11. Compared with patients with CD19+ DLBCL, those with CD19- DLBCL more frequently showed elevated lactate dehydrogenase (LDH) levels (73%, P= .011). Morphologically, 15 (79%) of the 19 CD19- DLBCL patients examined showed plasmablastic/plasmacytoid differentiation. Patients with CD19- DLBCL expressed BCL2 protein less frequently than CD19+ DLBCL (P= .042). Especially noteworthy is that half of the patients with CD19- DLBCL died within 2 years after diagnosis. The CD19- DLBCL group showed a survival curve significantly inferior to that for the CD19+ group (P= .034, generalized Wilcoxon test). Our findings demonstrate that loss of CD19 expression in DLBCL is associated with elevated serum LDH levels and a poor prognosis, especially during the early follow-up period.

CD21S antigen expression in tumour cells of diffuse large B-cell lymphomas is an independent prognostic factor indicating better overall survival.

To evaluate the clinical significance of CD21S expression of diffuse large B-cell lymphoma (DLBCL) tumour cells, we compared their clinical features, immunophenotype, response to therapy and outcome in relation to CD21S expression. Between 1987 and 1999, frozen sections from 240 DLBCL cases were examined for CD21S expression by immunohistochemical methods. CD21S expression was detected on the tumour cells of 87 (36%) cases. The median age of the CD21S(+) DLBCL cases was 65 years (range: 17-84 years), the male-female ratio was 42:45, and they showed the following clinical features: Eastern Cooperative Oncology Group score >1 in 14%, lactate dehydrogenase greater than normal levels in 38%, extranodal sites >1 in 14%, stages III/IV disease at diagnosis in 29%, B symptoms in 17%, and a high/high-intermediate International Prognostic Index (IPI) in 23%. They also showed a better overall survival (P = 0.00001, log-rank test) and a better complete remission rate (P = 0.00004, chi-square test) than CD21S(-) DLBCL. Moreover, CD21S(+) DLBCL showed a better survival than CD21S(-) DLBCL for both low/low-intermediate and high/high-intermediate risk categories of IPI (P = 0.045 and P = 0.0016 respectively). Multivariate analysis identified CD21S expression as an independent factor for survival when compared with the five IPI factors. These findings indicate that CD21S expression of DLBCL tumour cells is a useful prognostic factor for survival.